The term "gastroesophageal reflux disease" refers to reverse the promotion of gastric contents through the lower esophageal sphincter into the esophagus.
Indicator gastric acidity content is normally 1.5-2.0 (low value due to the acidity of hydrochloric acid secretion). In contrast, the contents of the esophagus has acidity indices close to neutral (6.0-7.0).
With the development of gastroesophageal reflux in the esophagus acidity significantly shifted to lower values due to contact with the acidic gastric contents. Prolonged contact of the esophageal mucosa with acidic stomach contents, besides containing digestive enzymes, contributes to its inflammation.
Bile acids, enzymes, bicarbonates, are part of the contents of the duodenum are also able to have a strong damaging effect on the mucous membrane of the esophagus. When casting these substances in the stomach can also watch their progress in the esophagus.
Gastroesophageal reflux is a normal physiological manifestation if it meets the following criteria:
- It develops mainly postprandial;
- not accompanied by discomfort;
- refluxes duration and frequency for a small day;
- at night refluxes small frequency.
Gastroesophageal reflux disease should be regarded as painful, if it has the following characteristics:
- frequent and / or prolonged episodes of reflux;
- Reflux episodes recorded in the daytime and / or nighttime;
- gastric content into the esophagus accompanied by the development of clinical symptoms, inflammation / damage esophageal mucosa.
Causes
Several factors contribute to the development of gastric contents into the esophagus casting. Among them:
- the failure of the lower esophageal sphincter;
- episodes of transient lower esophageal sphincter relaxations;
- insufficient esophageal clearance;
- pathological changes in the stomach, which enhance the expression of physiological reflux.
Protective "antireflux" function of the lower esophageal sphincter is ensured by maintaining the tone his musculature sufficiently long sphincter area and location part in the abdominal area sphincter cavity. At a sufficiently high pressure part of the patients revealed a decrease in lower esophageal sphincter; in other cases, there are episodes of transient relaxation of his muscles.
It was found that in maintaining the tone of the lower esophageal sphincter play the role of hormonal factors. Several drugs and certain foods contribute to reduce the pressure in the lower esophageal sphincter and development or maintaining reflux.
Location portion sphincter area in the abdominal cavity, below the diaphragm, serves wise adaptive mechanism that prevents gastric content into the esophagus at the height of inspiration, in the time when it is promoted by increasing intra-abdominal pressure.
At the height of the inhalation in normal conditions, there is a "clamping" of the lower segment of the esophagus between the legs of the diaphragm. In the case of formation of hiatal hernia finite segment of the esophagus moves above the diaphragm. "Pinch" of the upper part of the stomach legs diaphragm violates the evacuation of the acidic contents of the esophagus.
By reducing the esophagus it supports the natural cleansing of the esophagus from acidic content, and normal rate intraesophageal acidity of not more than 4. Natural mechanisms by which carried out the cleansing, the following:
- motor activity of the esophagus;
- salivation; bicarbonates in saliva neutralize the acidic contents.
Disturbances from these units helps to reduce "cleansing" of the esophagus has fallen into the acidic or alkaline contents.
reflux symptoms
Manifestations of gastroesophageal reflux disease characterized by a variety of symptoms that can occur in isolation or in combination. According to the results of special studies, symptoms of gastroesophageal reflux detected in 20-40% of the population of developed countries (according to some sources - almost half of the adult population). Daily symptoms of gastroesophageal reflux disease experience up to 10% of the population every week - 30% monthly - 50% of the adult population.
The most characteristic manifestations include:
- heartburn;
- regurgitation;
- pain in the chest and on the left side of the chest;
- painful swallowing;
- prolonged cough, hoarseness;
- destruction of tooth enamel
Unfortunately, the severity of the clinical manifestations is not fully reflect the severity of reflux. More than 85% reduction in episodes intraesophageal pH below 4 is not accompanied by any sensations.
Diagnostics
Grade changes during esophageal gastroesophageal reflux disease by upper GI endoscopy with biopsies It allows not only to assess the degree of esophageal lesions, but also to conduct a differential diagnosis esophagitis.
X-ray examination of the esophagus with barium reveals anatomical disorders of the esophagus and stomach, which contribute to the formation of gastroesophageal reflux (hiatal hernia Aperture).
24-hour monitoring intraesophageal acidity plays an important role in the confirmation of the presence of gastroesophageal reflux.
Treatment of gastroesophageal reflux disease
Therapeutic measures during gastroesophageal reflux disease should be aimed at reducing the severity of reflux, reducing gastric damaging properties, enhancing esophageal cleansing, protecting the mucosa esophagus.
It is important to compliance with the general measures that help to reduce the severity of gastric content into the esophagus. They include:
- normalization of body weight (in patients with overweight, this measure allows to reduce the degree of severity of failure of the lower esophageal sphincter);
- exception of smoking, reducing alcohol intake, limit fat intake of food, coffee, chocolate (These effects help to reduce the tone of the lower esophageal sphincter, fatty foods slows activity of the stomach);
- elimination of acidic foods, which usually provokes the appearance of heartburn;
- eating small meals regularly;
- meal no later than 2 hours before bedtime;
- loads avoidance associated with increased intra-abdominal pressure;
- sleep on the bed, the head end is raised by 10-15 cm.
More a diet with esophagitis
With the ineffectiveness of such measures prescribed antacids. Antacids - group of drugs containing in its composition an aluminum salt, magnesium, calcium, which neutralize the hydrochloric acid. In addition, antacids are able to bind and decrease the activity of digestive enzyme of gastric juice, bile acids and lysolecithin - included in the bile and having a damaging effect on gastric mucosa and esophagus.
It is preferable to take antacids in the form of gels. The lumen of the esophagus and stomach gels form small droplets, which enhances their effect. At present, in the form of gels produced Almagel, Fosfalyugel, Maalox, Remagel. In these preparations contain aluminum salt or aluminum and magnesium salts in various ratios.
Antacids taken 30 minutes before meals and at bedtime (when possible it is desirable to take the drug in the supine position, with small throats).
If no effect of antacids and in the presence of endoscopic signs of esophagitis necessary appointment prokinetics and / or antisecretory drugs.
As prokinetics patients with gastroesophageal reflux disease domepridona assignment shown in connection with the presence of systemic side effects of metoclopramide. Assigned Domperidone 10 mg 4 times a day.
If a patient requires additional erosive esophagitis assignment of proton pump inhibitors (20 mg rabeprazole overnight, omeprazole 20 mg 2-3 times a day).
The duration of treatment of erosive esophagitis should be at least 8 weeks; in the healing erosions necessary maintenance therapy domperidone (20 mg / day), proton pump inhibitors (rabeprazole 10-20 mg / day omeprazole 20 mg / day) or a combination thereof.
Forecast
Complications of gastroesophageal reflux disease are observed in 10-15% of patients and determine the prognosis of the disease course. In severe reflux esophagitis may develop ulcers and narrowing of the esophagus, esophageal bleeding.
